Cestodes

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Cestodes : 

Cestodes -Varun C N

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Diphyllobothrium latum (Fish tapeworm) Morphology Adult worm Longest tapeworm in humans Has 3 parts- Scolex, neck and strobila Ivory colored Scolex Almond shaped It bears 2 slit like grooves- “Bothria” No rosetellum and hooklets 2 Varun C N- Cestodes

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Neck Present below the scolex Thin, unsegmented Long in length compared to scolex Strobila More than 3000 proglottids Immature, mature and gravid proglottids Hermaphroditic in nature Eggs are discharged periodically Single worm discharge as many as million eggs/ day 3 Varun C N- Cestodes

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Egg Bile stained Contains immature embryo Operculated egg Not effective to humans Thin eggs with operculum at one end and knob at other 4 Varun C N- Cestodes

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Definitive host- Humans First Intermediate host- Small copepods Second Intermediate host- Freshwater fishes Infective form- Plerocercoid larva Mode of infection- Ingestion of Fish containing larval forms 5 Varun C N- Cestodes

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Water Copepods Fish 6 Varun C N- Cestodes

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Clinical manifestations Intestinal obstruction, diarrhea, and abdominal pain Pernicious anemia Laboratory diagnosis Demonstration of eggs in fecal samples by Direct examination Concentrated by Formol-ether method 7 Varun C N- Cestodes

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Prophylaxis Proper cooking Flash freezing of raw fish Effective sanitation Treat the carriers Treatment Praziquantel or Niclosamide 8 Varun C N- Cestodes

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Taenia saginata and Taenia solium Other name Taenia saginata- Beef tapeworm, unarmed tapeworm of man Taenia solium- Pork tapeworm, armed tapeworm of man Distribution- World wide 9 Varun C N- Cestodes

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T. saginata T. solium 12 Varun C N- Cestodes

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Figure A: Taenia saginata has 15 to 20 uterine branches in each segment (proglottid).Figure B: Taenia solium has 7 to 13 uterine branches 13 Varun C N- Cestodes

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Eggs: Thick, striated shell. Eggs of T.solium and T. saginata are indistinguishable and species identification should be made from proglottids or scoleces. When excreted Embryonated. 6- hooked oncosphere present inside a thick shell. 14 Varun C N- Cestodes

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Life cycle 15 Varun C N- Cestodes

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Clinical symptoms T saginata produces mild discomfort and abdominal pain T solium larval forms develop in other parts of body and cause related symptoms. The most dangerous is Neurocysticercosis Other organ cysticercosis is also seen 18 Varun C N- Cestodes

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An extraordinary huge cysticercosis pseudo tumour 1.5kg was completely excised. Uledi SJ. A rare gigantic solitary cysticercosis pseudotumour of the neck. JSCR. 2010 9:5 20 Varun C N- Cestodes

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Lab diagnosis Diagnosis of intestinal taeniasis can be made by recovery of the characteristic ova in the stool. The diagnosis of cysticercosis depends upon serology Calcified cysticerci are less often seen in the brain Calcification in muscles usually appears three to five years after initial infection, and are most typically seen as spindle-shaped calcifications, most numerous in the thighs. Occasionally, the diagnosis is made histologically on surgical specimens. 21 Varun C N- Cestodes

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Prophylaxis Proper Cooking All Meat consumed should be checked for cysticercosis Proper sanitary disposal Treat all infected people 22 Varun C N- Cestodes

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Hymenolepis nana (Dwarf tapeworm) H. nana is the most common cause of all cestode infections and is encountered worldwide 23 Varun C N- Cestodes

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Adult Worm Scolex Globular 4 cup shaped suckers Rosetellum armed with a single row of hooklets Neck Long and slender Strobila About 200 proglottids Hermaphroditic Genital pores are lateral 24 Varun C N- Cestodes

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Eggs: Non operculated On the inner of the two membranes surrounding are two poles, from which 4 to 8 polar filaments spread out between the two membranes. The oncosphere, or larval stage, has six hooks. 25 Varun C N- Cestodes

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Life cycle Infectious form: Mature Egg Route of infection: Ingestion Natural Host: Human Reservoir Host; Rats When eaten by a person or rodent, eggs hatch in the duodenum, releasing oncospheres, which penetrate the mucosa and come to lie in lymph channels of the villi. Oncospheres develop into cysticercus larvae which have a neck behind a well formed scolex. In five to six days cysticercoids emerge into the lumen of the small intestine, where they attach, mature, and produce eggs. 26 Varun C N- Cestodes

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Life cycle Direct Indirect 28 Varun C N- Cestodes

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Clinical symptoms Infections due to H. nana may cause no symptoms even with heavy worm burdens. Restlessness, irritability, anorexia, abdominal pain and diarrhea Heavy worm burdens may be caused by auto-infection which can be a problem in the immunocompromised. Laboratory Diagnosis Diagnosis is based on recovery and identification of the characteristic ova in a Formol-ether concentrate of feces. Adult worms and proglottids are rarely seen in stool samples 29 Varun C N- Cestodes

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Don’t get Confused. This is not H nana. Its his brother- H diminuta No polar filaments 30 Varun C N- Cestodes

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Echinococcus granulosus 31 Varun C N- Cestodes

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Morphology Adult Worm: Scolex: Pyriform in shape 4 suckers and a protrusible rosetellum Double row of hooklets Neck Thick and short Strobila 3 segments- immature, mature and gravid 32 Varun C N- Cestodes

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Eggs: Morphologically indistinguishable from Taenia species 33 Varun C N- Cestodes

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Life cycle: Definitive hosts- Feline animals Indefinitive hosts- Cattles Accidental hosts- Man Infective form- Mature Eggs Mode of infection- Ingestion Agent causing infection in humans- Larva 35 Varun C N- Cestodes

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Pericyst Ectocyst Endocyst Brood capsules Hydatid Fluid Fig: Structure of Hydatid Cyst 37 Varun C N- Cestodes

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Hydatid Fluid Clear and pale yellow Sp gravity of 1.005-1.010 pH is slight acidic (aprox 6.7) Highly antigenic Centrifuged deposits of hydatid fluid shows free solices, hooklets and detached brood capsules. It is called as hydatid sand. 38 Varun C N- Cestodes

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Laboratory diagnosis: 1. Casoni Test Man's arm showing positive skin test for hydatid disease 40 Varun C N- Cestodes

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2. Serological diagnosis 3. Surgical removal of Hydatid cyst and examination 4. Histology 5. Radio diagnosis 41 Varun C N- Cestodes

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That’s all………. The End 42 Varun C N- Cestodes